Your health with Pharmacist Advice

Senior's Health - Osteoarthritis

DEFINITION

Osteoarthritis is a degenerative joint disease and is the most common joint disorder.(1)

DESCRIPTION

Osteoarthritis is classified as primary, where the cause is unknown or secondary, where the Osteoarthritis is caused by another disease, infection, deformity, injury or overuse of a joint. Many people are affected to some degree by Osteoarthritis by the time they reach the age of 70. Osteoarthritis affects men and women equally, though men tend to develop it at an earlier age than women.(2)

SIGNS AND SYMPTOMS

The symptoms of Osteoarthritis usually develop gradually and most commonly affect one or a few joints at first. Commonly affected joints include the fingers, base of the thumbs, neck, lower back, big toes, hips and knees. Early symptoms include pain that is made worse by exercise and morning joint stiffness that improves around 30 minutes after the joint starts to be moved.

As the damage from Osteoarthritis worsens, the joint may become very difficult to move and may freeze in a bent position. Joints can increase in size and they may grate or crackle when they are moved. Bony growths often develop in the joints at the ends of the fingers. Knee joints affected by Osteoarthritis can become unstable due to the stretching of ligaments surrounding the joint. In contrast, Osteoarthritis that affects the hip can cause it to become stiff. Osteoarthritis can affect the spine, causing back pain and even numbness, odd sensations, pain and weakness in an arm or leg.(3)

HEALTH MANAGEMENT

As with all conditions, your Doctor should be consulted to diagnose and treat this condition. Treatment of Osteoarthritis can include appropriate exercises, lifestyle changes, physical therapy (e.g. heat treatment), medications for pain and/or inflammation and sometimes surgery. It is important for your Doctor to diagnose joint pain. In some cases the pain may not be coming from a joint but may be the result of tendonitis or a pinched nerve(4).

Until recently the only way to detect Osteoarthritis was through an x-ray after the condition has progressed. Recent clinical research shows that a different type of scan called an MRI (Magnetic Resonance Imaging) may be able to detect small changes in cartilage that indicate when a person is in the very early stages of developing the disease. By identifying a person who is at risk of developing Osteoarthritis, lifestyle changes such as weight loss can be implemented. This type of early intervention may reduce the future need for medication and surgery(5).

CURRENT TREATMENT OPTIONS

  • Appropriate exercises can help maintain healthy cartilage, increase the range of motion of a joint and strengthen surrounding muscles. Exercises may include stretching, strengthening and postural exercises. Exercise should be balanced with rest of painful joints.
  • The combination of weight loss and exercise is significantly better than either one of these interventions alone in reducing pain and improving function in overweight patients with knee Osteoarthritis(6).
  • Very soft chairs, recliners, mattresses or car seats may worsen symptoms. Your Doctor may recommend using straight-backed chairs, firm mattresses and bed boards. Back supports or braces may be needed if the Osteoarthritis affects the spine.
  • Physical therapy such as heat treatment, splints or supports and massage may be suitable for certain affected joints.
  • Analgesics, NSAIDs, and injected steroids are drugs that may be prescribed for the treatment of pain and inflammation associated with Osteoarthritis.
  • Joint replacement surgery of the hip or knee may be an option if all other treatments have failed to bring relief.(7)

PHARMACIST

  1. Follow the diet hints.
  2. Paracetamol or NSAIDs (nonsteroidal anti-inflammatories) may be suggested for pain relief. Paracetamol is considered suitable to ease the pain of Osteoarthritis. Ask your Pharmacist for advice as there are possible side effects.
  3. Paracetamol and codeine in combination may be recommended for Osteoarthritis pain which does not respond to paracetamol. Codeine may cause constipation in some people.(8)
  4. A variety of over-the-counter topical analgesics are available. These are usually creams or gels which may be rubbed into the painful area several times a day. Such creams should not be applied to broken or irritated skin, and hands must be washed well after application. If it is your hands that are being treated, wear a pair of light cotton gloves to prevent creams from getting into the eyes(9). Creams may interact with oral medications, so always ask your Doctor or Pharmacist before commencing a new treatment.
  5. Ask your doctor about the most suitable exercise Programme for this condition. (See the Osteoarthritis - Exercise topic for more information).
  6. Relief from Osteoarthritis may be obtained from heat treatment, splints and/or supports. Ask your Pharmacist for advice.
  7. Functional aids such as walking sticks or forearm support crutches are available. Ask your Pharmacist for advice and see the Arthritis - Bathroom Aids, Arthritis - Dressing Aids, Arthritis - Gardening Aids and Arthritis - Grooming Aids topics on the Healthpoint.
  8. Lose weight if necessary. Excess weight increases the risk of Osteoarthritis of the knee.(10) Weight loss can reduce the severity of pain in the knee and hip(11). Ask your Pharmacist for advice.
  9. Consider taking the supplements recommended in this topic.

DIET HINTS

Osteoarthritis may, in some cases, respond to dietary changes.

  • The diet generally should be rich in fish oils such as salmon, tuna, mackerel and mullet. Fish oils may help to regulate the inflammatory process.(12) (13)
  • It is recommended that you include vitamin C rich foods in the diet(14).
  • Foods rich in silicon may be beneficial for Arthritis sufferers. These include wholegrain cereals, nuts and apples(15).
  • Weight control is important. This will help minimise the load on inflamed joints(16). (See the Weight Management Diet topic for more information).
  • Certain food groups such as the "nightshade" vegetables (potato, tomato, eggplant, chilli and capsicum) and salicylate-rich foods (see examples in the Hives and Hyperactivity Diet topic) may aggravate Osteoarthritis. Check for food sensitivities, particularly dairy and wheat. This should be assessed on an individual basis with the help of a qualified Dietitian(17).

VITAMINS/MINERALS/HERBS

Nutritional supplements are only to be used if the dietary vitamin intake is inadequate.

  • Glucosamine and chondroitin may provide relief from symptoms of Osteoarthritis.(18)
  • Herbs such as devil's claw,(19) feverfew, celery and white willow bark have traditionally been used to relieve the pain and inflammation associated with Osteoarthritis(20).
  • Bromelain is an anti-inflammatory enzyme derived from pineapple, which may provide symptomatic relief(21).
  • Vitamin C with bioflavonoids is believed to have a positive effect on cartilage and protein synthesis(22).
  • Vitamin E may play a role in reducing inflammation associated with Osteoarthritis(23).